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Even hydrolysed cow's milk formulae may retain residual allergens and there are few nutritional options for children with cow's milk allergy (CMA) who also react to soy. To assess clinical tolerance to a rice-based hydrolysate in children with such a clinical presentation. Eighteen children (six girls and 12 boys; median age 5 years; range 1–9 years) with CMA, who developed clinical reactions to a soy-based formula after 2–18 months' treatment, were recruited between January 1998 and June 1999. Clinical evaluation was by skin prick test (SPT) with cow's milk, casein, lactalbumin, soy and rice allergen extracts, fresh cow's milk, soy and hydrolysated rice formula (HRF). Serology was investigated by CAP system technology and immunoblotting. Assessment of the rice formula was carried out by double-blind, placebo-controlled food challenge with rice hydrolysate. Thirteen children had positive SPT to casein, 10 to lactalbumin, eight to rice and two to rice hydrolysate. Positive serology was found in all patients' sera tested with cow's milk, with soy in 13 sera and with rice in seven. Double-blinded, placebo-controlled challenge with an HRF was negative in all cases. Children allergic to cow's milk and soy tolerate an HRF clinically. This suggests that rice hydrolysate may be used as a protein source for children with multiple food-induced reactions. [ABSTRACT FROM AUTHOR]

Presents a study that investigated the structural features of the S6 transmembrane segment of the calcium-activated potassium channel of intermediate conductance IKCa cloned from HeLa cells using cysteine scanning mutagenesis and computer-based modeling. Characterization of the recombinant IKCa channel cloned from HeLa cells; Effects of [2-(trimethylammonium) ethyl] methanethiosulfonate bromide on S6 segment residues; Influence of the charge on methane-thiosulfonate channel interactions.

Background: Creatine (Cr) levels are strongly dependent on diets, including animal-derived proteins. Cr is an important metabolite as it represents a source of stored energy to support physical performance and potentially sustain positive effects such as improving memory or intelligence. This study was planned to assess Cr levels in PKU children adhering to a diet low in phenylalanine (Phe) content and compared with those of children with mild hyperphenylalaninemia (MHP) on a free diet. Methods: This retrospective pilot study analyzed Cr levels from Guthrie cards in 25 PKU and 35 MHP subjects. Anthropomorphic and nutritional data of the study populations were assessed, compared and correlated. Results: Cr levels of PKU subjects were significantly lower than those of MHP subjects and correlated to the low intake of animal proteins. Although no deficiencies in PKU subjects were identified, PKU subjects were found to have a 26-fold higher risk of displaying Cr levels <25° percentile than MHP counterparts. Conclusions: This pilot study suggests that Cr levels might be concerningly low in PKU children adhering to a low-Phe diet. Confirmatory studies are needed in PKU patients of different age groups to assess Cr levels and the potential benefits on physical and intellectual performance of Cr supplementation. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is the main cause of death and morbidity in the world. There is a strong evidence that the atherosclerotic process begins in childhood and that hypercholesterolaemia is a CHD major risk factor. Hypercholesterolaemia is a modifiable CHD risk factor and there is a tracking of hypercholesterolaemia from birth to adulthood. Familial hypercholesterolaemia (FH) is the most common primitive cause of hypercholesterolaemia, affecting 1:200–250 individuals. Early detection and treatment of hypercholesterolaemia in childhood can literally "save decades of life", as stated in the European Atherosclerosis Society Consensus. Multiple screening strategies have been proposed. In 2008, the American Academy of Pediatrics published the criteria for targeted screening, while some expert panels recommend universal screening particularly in the young, although cost effectiveness has not been fully analysed. Blood lipid profile evaluation [total cholesterol, Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C) and triglycerides] is the first step. It has to be ideally performed between two and ten years of age. Hypercholesterolaemia has to be confirmed with a second sample and followed by the detection of family history for premature (before 55 years in men and 60 years in women) or subsequent cardio-vascular events and/or hypercholesterolaemia in 1st and 2nd degree relatives. The management of hypercholesterolaemia in childhood primarily involves healthy lifestyle and a prudent low-fat diet, emphasising the benefits of the Mediterranean diet. Statins are the cornerstone of the drug therapy approved in USA and in Europe for use in children. Ezetimibe or bile acid sequestrants may be required to attain LDL-C goal in some patients. Early identification of children with severe hypercholesterolaemia or with FH is important to prevent atherosclerosis at the earliest stage of development, when maximum benefit can still be obtained via lifestyle adaptations and therapy. The purpose of our review is to highlight the importance of prevention and treatment of hypercholesterolaemia starting from the earliest stages of life. [ABSTRACT FROM AUTHOR]

Merkel cell carcinomas are uncommon malignant tumors thought to originate from the neuroendocrine cells of the skin that mainly affects sun-exposed body areas, particularly the head and neck. In approximately 10% of cases, they present with localized lymphadenopathy without any clinical evidence or history of a primary lesion, but a truly primary lymph node Merkel cell carcinoma may occur, possibly originating from epithelial inclusions or an anomalous neuroendocrine differentiation of hematopoietic stem cells. It has been observed that Merkel cell carcinoma is more likely to affect patients whose immune status is impaired as a result of iatrogenic immunosuppression, human immunodeficiency virus infection, or hematological malignancies. This study reports the case of a bona fide primary Merkel cell carcinoma arising in an intraparotid lymph node of a patient infected by HIV that had a particularly unfavorable clinical course. [ABSTRACT FROM PUBLISHER]

Objective: The objective of our prospective monocentric work was to determine the diagnostic value of real-time elastography (RTE) in the assessment of liver fibrosis in patients with iron overload, using transient elastography (TE) as reference standard. Methods: Sixty-seven consecutive patients with MRI detectable iron overload (T2*<6.3ms) were enrolled. TE and RTE were performed on the same day as MRI. Elastograms were acquired by an experienced operator and analyzed by calculating the elastic ratio between perihepatic soft tissues and liver parenchyma. An elliptical ROI of 1cm2 (Z 1) was positioned in the liver parenchyma and a smaller elliptical ROI of 2mm2 (Z 2) was positioned in a homogeneously soft (red) region of the diaphragm, which was considered as internal control to calculate the elastic ratio Z 2/Z 1. Results: Seven patients were excluded because of invalid TE or RTE examinations. The remaining 60 patients were 57% males and 43% females (mean age: 42 [21–76] years), including 37 homozygous-β-thalassemics, 13 patients with β-thalassemia intermedia, 6 with primary hemochromatosis, and 4 with myelodysplastic syndrome. Increasing elastic ratios were significantly correlated with increasing TE values (r =0.645, 95% CI 0.468–0.772, P <0.0001). The mean elastic ratios for each METAVIR group were as follows: F0/1=1.9±0.4; F2=2.2±0.4; F3=2.9±0.5; F4=3.2±0.4. The diagnostic accuracy of RTE for F ≥2 evaluated by AUC-ROC analysis was 0.798 (95% CI 0.674–0.890). The diagnostic accuracy of RTE for F ≥3 was 0.909 (95% CI 0.806–0.968). At a cut-off≥2.75, RTE showed a sensitivity of 70% (95% CI 45.7–88.1) and a specificity of 97.5% (95% CI 86.8–99.9). Conclusions: In patients with MRI-detectable liver iron-overload RTE allows to discriminate between F0/1–F2 and F3–F4 with a reasonable diagnostic accuracy. [ABSTRACT FROM AUTHOR]

This study examined the effectiveness of the manual for obesity Perdere peso senza perdere la testa (Losing weight without losing your mind) used in form of guided self-help on 161 patients. Three levels of treatments were compared: (a) guided self-help treatment (GSH); (b) minimal guided self-help treatment (M-GSH); (c) control condition (CC). At the end of the treatment, a significant reduction in body weight was observed in GSH and M-GSH, but not in the CC. At six-month follow-up 32.7% of GSH subjects and 15.1% of M-GSH subjects were able to maintain at least a 5% weight loss. The findings show that GSH is more effective than M-GSH in determining a significant short-term reduction of body weight.

We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed.

Streptococcus pneumoniae causes lobar pneumonitis but primary peritonitis can occur in cyrrotic adults as well as in children affected by nephrosis and immunopathies. In young females peritonitis can be the consequence of infection localized at genital organs. Pneumococcal sepsis is becoming rare with the antibiotic era but resistance to penicillin is actually frequent and is becoming a problem for elderly. We report a case of a young woman affected by spontaneous primary peritonitis and pneumococcal sepsis. The prevalent symptoms were gastrointestinal: diarrhea and emesis. No infectious foci could be detected on imaging studies and during surgery.

Objective: The purpose of the study was to evaluate the role of sonography in diagnosing traumatic tears of the quadriceps tendon. More specifically, it was intended to determine the value of sonography in differentiating complete from partial tears and thus in directing therapy. Knees of asymptomatic volunteers and patients' contralateral knees were used as normal standards., Subjects and Methods: Sonography was performed in 29 patients with injuries of the quadriceps tendon in a 3-year period. As the control, 59 normal knees were examined: both knees of 15 healthy subjects and 29 contralateral knees of the injured patients. In all cases, longitudinal and transverse sonograms were obtained. In five cases (four complete and one partial rupture), the sonographic diagnosis was confirmed surgically. Those remaining patients who had a partial tendon tear were treated conservatively. Follow-up sonograms were obtained in 10 cases (three treated with surgery and seven not) and showed integrity of the affected tendon., Results: Among the 29 patients, sonograms showed a partial rupture (focal hypoechoic defect in the tendon) in eight and a complete rupture (complete disruption of the tendon fibers) in four. In the remaining 17 cases, the tendon was intact. The high sensitivity and specificity of sonography (100% or four of four in our sample) in the diagnosis of complete tears of the quadriceps tendon were confirmed by surgery. As only one partial tear was confirmed by surgery (the remaining seven were treated conservatively), the sensitivity and specificity of sonography with respect to partial tears could not be determined., Conclusion: Results of this study, albeit obtained from a limited sample, indicate that sonography offers a high degree of sensitivity and specificity in the evaluation of quadriceps tendon rupture. This noninvasive and easily available imaging technique should be considered in the diagnostic workup and treatment planning of patients with suspected tears of the quadriceps tendon.

A retrospective sonographic study of soft tissue masses of the hand was undertaken. A spherical fluid-filled structure with a well-defined wall was seen in 13 patients and the cases were diagnosed as ganglia. This diagnosis had been generally suspected clinically in the presence of a firm nonpainful lump. This study indicates that ultrasound is a valuable diagnostic tool for the study of soft-tissue masses of the hand and in the differential diagnosis of other soft tissue lesions, such as pigmented villonodular synovitis or tenosynovitis.

By means of a silver staining method, Nucleolar Organizer Region-associated proteins (NORs) have been evaluated on paraffin sections of a series of 58 ultrasound-guided liver biopsy specimens. These included 12 normal livers, 12 cirrhotic livers, 12 cases of chronic hepatitis and 22 cases of hepatocellular carcinoma. A significant difference (P less than 0.001) was found between the mean AgNOR scores of the normal and pathological biopsies, and between the non-neoplastic and the carcinomatous lesions. The authors suggest that AgNOR counts, in combination with conventional histocytological criteria, may be a useful method in the diagnosis of liver diseases.

The quantitative study of neoplastic growth patterns is the ground for a correct clinical approach to patients with malignant tumors, for both prognosis and evaluation of treatment outcome. The growth of 19 hepatic metastases in 13 patients was therefore followed; the lesions diameters were measured by means of US and their volumes were calculated. The results were plotted in semilogarithmic scale and doubling times (DT) were calculated. The DT values observed were ordered according to the origin of the tumors and to their growth rate; our values were in substantial agreement with literature data. Moreover, the differential increase in the metastases diameters along the 3 orthogonal planes was analysed and a significant rate of asymmetrical growth was shown. Changes in the echo structure of the observed metastases were evaluated and the changes in peripheral hypoechoic halo were demonstrated. The authors stress the importance of a correct volumetric study during US follow-up of patients with hepatic metastases.

Microscopic leukemia infiltration of kidneys is a common autoptic finding in children for ALL before starting specific treatment. However, a palpable renal enlargement is uncommon. The authors have performed an intravenous pyelogram (IVP) in 139 pediatric cases of acute leukemia, 117 of whom ALL, the remaining 22 ANLL. ALL patients were divided in 3 groups; Group 1 was made of 18 children treated with IGG-74 protocol, independently by any prognostic factor; Group 2 included 46 patients presenting one or more negative factors; Group 3 was of 53 cases with no unfavourable factor. Abnormal IVP was found in 4/18 (22,2%) Group 1, 9/46 (19,5%) Group 2, 2/53 (3,8%) Group 3 ALL patients. The most common anomaly was a bilateral renal enlargement with normal or slightly compromised renal function. Only 3 out of 117 ALL children had palpable renal masses. All 15 children acquired CR within one month from starting therapy together with normalization of IVP. Six out of 15 of these cases died, one is alive with disease, 8 are alive in CR. Except for two cases, all presented other negative prognostic factor associated with abnormal IVP. One of 22 ANLL children had an abnormal IVP: only one kidney was involved with the unique mechanism of intraparenchimal hemorrhage and hydronephrosis due to the filling of renal pelvis and ureter by multiple coarse cloths. In conclusions, major renal alterations are present in about 10% of ALL children, rarely in ANLL. This finding is commonly associated with unfavorable prognostic factors.

Personal experience of the current possibilities of ultrasonography in the diagnosis of visceral ischaemic syndrome is reported.

The radiologic findings in 13 patients with pathologically proved adrenal myelolipomas were reviewed. All lesions involved the right adrenal gland; they ranged from 2 to 9 cm in diameter. Sonograms showed hyperechoic tumors in 11 cases (five homogeneous, six heterogeneous). Two myelolipomas composed primarily of myeloid tissue were hypoechoic. A propagation speed artifact was seen in seven lesions, all of which were composed primarily of fat and larger than 4 cm. CT identified fat-density tissues in all lesions. Contrast-enhanced CT showed positive attenuation values in the two predominantly myeloid tumors. CT appears to be sensitive for the diagnosis of adrenal myelolipomas. However, precontrast images are required to avoid errors.

Three cases of gastrointestinal perforation diagnosed by ultrasonography (US) are described. In these patients US showed the presence of gas in peritoneum, anteriorly to the liver. Gas is easily identified by US for its unique aspects. More difficult may be the diagnosis of its site, external to the gastrointestinal tract. Differential diagnosis, limits and possible pitfalls are briefly discussed.